When Cancer Spreads to the Bone What is bone metastasis? As a cancerous tumor grows, cancer cells may break away and be carried to other parts of the body by the blood or lymphatic system. This is called metastasis. It is called metastases when there are multiple areas in the bone with cancer. One of the most common places cancer spreads to is the bones, especially cancers of the breast, prostate, kidney, thyroid, and lung. When a new tumor develops in the bones as a result of metastasis, it is not called bone cancer. Instead, it is named after the area in the body where the cancer started. For example, lung cancer that spreads to the bones is called metastatic lung cancer. What are the symptoms of bone metastasis? When cancer spreads to the bones, the bones can become weak or fragile. Bones most commonly affected include the upper leg bones, the upper arm bones, the spine, the ribs, the pelvis, and the skull. Bone pain is the most common symptom. Bone breaks, called fractures, may also occur. Bones damaged by cancer may ONCOLOGY. CLINICAL SOCIETY AMERICAN OF 2004 © LLC. EXPLANATIONS, MORREALE/VISUAL ROBERT BY ILLUSTRATION also release high levels of calcium into the blood, called hypercalcemia, which may be detected in your blood work. If the cancer is advanced, this can cause nausea, fatigue, thirst, frequent urination, and confusion. If a tumor presses on the spinal cord, a person may feel weakness or numbness in the legs, arms, or abdomen, or develop constipation or the inability to control urination. How are bone metastases detected? Bone metastases may be found when the primary cancer is diagnosed. Or, if a person is having symptoms, a doctor may recommend having specific tests depending on the types of symptoms and where pain is felt. Imaging tests that may be recommended include x-rays, bone scans, computed tomography (CT) scans, positron emission tomography (PET) scans, and magnetic resonance imaging (MRI) scans. Laboratory tests may be used to check blood or urine for high levels of substances that are released into the body by damaged bones. A bone biopsy may be done if other tests cannot determine whether cancer has spread to the bones. How are bone metastases treated? Treatment of bone metastases aims to stop or slow the growth of a tumor, prevent further bone damage, and manage pain or other symptoms. The treatment or combination of treatments used depends on the type of primary cancer that was diagnosed, the location and number of tumors, the person’s overall health, and which treatments the person has already received. Bone-modifying drugs may be given. These medications slow bone thinning, reduce pain, and decrease hypercalcemia. A bone metastasis that is located only in 1 area is commonly treated with radiation therapy to relieve pain and strengthen the bone. Surgery may be used to remove a tumor or prevent or treat a bone fracture. A special cement can be injected into a bone to stabilize it. Chemotherapy, hormone therapy, and the use of radioactive drugs are treatment options if bone metastases are found in more than 1 area. You and your doctor may also consider a clinical trial. Clinical trials are an option to consider for treatment and care for all stages of cancer. The side effects of these treatments can often be prevented or managed with the help of your health care team. This is called palliative or supportive care and is an important part of the overall treatment plan. ASCO ANSWERS is a collection of oncologist-approved patient education materials developed by the American Society of Clinical Oncology (ASCO) for people with cancer and their caregivers. Questions to ask the health care team Words to Know Regular communication is important in making informed decisions about your health care. It can be helpful to bring someone along to your appointments to take notes. Consider asking your Bone biopsy: Removal of a tissue sample health care team the following questions: from the bone that is then examined under a microscope to check for cancer cells. ` Which bone or bones has my cancer spread to? ` Can you explain my test results to me? Bone scan: An imaging test used to find areas of abnormal bone that can be caused by injury, ` What does this mean for my prognosis (chance of recovery)? cancer, infection, or inflammation. ` Can you explain my treatment options? Chemotherapy: The use of drugs to destroy ` What clinical trials are available for me? Where are they located, and how do I find out more cancer cells. about them? ` Which treatments, or combination of treatments, do you recommend? Why? Clinical trial: A research study that tests a new treatment or drug. ` What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both? ` Should I see my dentist before beginning bone-strengthening treatment? Hormone therapy: Treatment that blocks hormones that cause cancer cells to grow. ` Can you explain the options for managing my pain with medication? ` In addition to medication, what other strategies can I use to manage bone pain? Oncologist: A doctor who specializes in treating cancer. ` How can a supportive care specialist help me keep my quality of life while I am getting treatment? Osteonecrosis of the jaw: Weakening and bone loss in the jaw; a rare side effect of some ` What follow-up tests will I need? bone-modifying drugs. ` How will bone metastases affect my daily life? What changes will I need to make to my daily routine to reduce the risk of bone fractures and to manage pain? Osteoporosis: A condition where the bones become thinner and more porous. ` Will bone metastasis prevent me from exercising, participating in sports, or doing any other activities? Is it safe to continue with my current activity level? Radiation therapy: The use of high-energy ` What long-term side effects may be associated with my cancer treatment? x-rays to destroy cancer cells. ` If I’m worried about managing the costs of my cancer care, who can help me? Radiopharmaceutical therapy: The use of ` Where can I find emotional support for me and my family? radioactive drugs to destroy cancer cells. ` If I have a question or problem, who should I call? Secondary (metastatic) tumor: A tumor that started in 1 part of the body and has spread to Find additional information and questions to ask the health care team at another. www.cancer.net/sideeffects. For a digital list of questions, download Cancer.Net’s free mobile app at www.cancer.net/app. This fact sheet was developed and is © 2020 American Society of Clinical Oncology, Inc. (ASCO). All rights reserved worldwide. No sponsor was involved in the development of the content. The mention of any company, product, service, or therapy does not constitute an endorsement of any kind by ASCO or Conquer Cancer®, the ASCO Foundation. It is the responsibility of the treating physician or other health care provider, relying on independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of the fact sheet or any errors or omissions. Information in ASCO’s patient education materials is not intended as medical advice or as a substitute for medical advice. Patients with health care-related questions should call or see their physician or other health care provider promptly and should not disregard professional medical advice, or delay seeking it, because of information encountered here. ASCO believes that all treatment decisions should be made between patients and their doctors. 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